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Easi-Sterilise Standard Operating Procedures. Introduction & Section 1 Cleaning Procedures. Housekeeping. Fire exits Bathrooms Mobile phones Tea and coffee Respect. Why are we here?. Patient and staff safety

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easi sterilise standard operating procedures

Easi-Sterilise Standard Operating Procedures



Section 1

Cleaning Procedures

  • Fire exits
  • Bathrooms
  • Mobile phones
  • Tea and coffee
  • Respect
why are we here
Why are we here?
  • Patient and staff safety
  • Directives from QH EMT for rapid implementation of education and training following incidents
  • Implementing a continuous quality improvement program
  • Targeting training needs not targeting individuals
  • Acknowledge an absence in effective communication when changes are made
  • To build on current level of knowledge in light of ever changing technology, standards, guidelines, advisories and legislation
qh commitment
Is to:

Appropriately train and skill staff

Provide information and resources so that step-by-step quality processes are consistently followed

Assist in identifying gaps in knowledge and provide opportunities for improvement

QH Commitment
aim of this workshop
Aim of this workshop

Provide participants with strategies to implement the SOPs and WSAs locally by improving and standardising knowledge on:

  • Pre-cleaning
  • Cleaning
  • Drying instruments
  • Packaging
  • Sterilising
  • Storage
  • Annual performance qualification/validation of the sterilisation process
sops wsas
  • To assist Oral Health facilities operationalise QH policy and guidelines
  • A resource for staff
  • Update and supersede the OH Critical Instrument Tracking (2003)
  • A framework to assist staff identify competence and areas where education and improvement may be needed
  • A resource to identify opportunities for improvement within the department that will require further education and training
section 1
Section 1

Cleaning Procedures

1 1 standard precautions
1.1 Standard Precautions

Standard precautions are applied as a first-line approach to infection control. These form the basis for your decision-making and practice. Standard precautions are a set of guidelines based on the assumption that all blood and body fluids are potentially infectious.

1 1 standard precautions11
1.1 Standard Precautions

In the context of sterilising practice and ALL the Standard Operating Procedures, standard precautions include:

  • Hand Hygiene
  • Hand cream – approved by infection control – not in packing area
  • Personal Protective Equipment
      • Gloves
      • Face shields, hair protection, safety glasses and masks
      • Fluid resistant gowns/aprons
  • OHS Requirements
1 2 soiled pickup collection
1.2 Soiled Pickup Collection
  • Standard Precautions - PPE
  • Contaminated items - dedicated collection trolley/cart
  • Keep instrument sets together
  • Follow the designated route with trolley (OHS)

Collection containers are:

  • puncture-resistant
  • leak-proof and made of either plastic or metal
  • with a lid or liner that can be closed
1 2 soiled pickup collection13
1.2 Soiled Pickup Collection

Cleaned items must be dried prior to transport

Reusable instruments cassettes and single items placed into designated transport containers

Secure single loose items


Place heavy instruments on light instruments

Lift above shoulder height

Containers should not exceed 10 kgs

containers for transport from surgery
Containers for Transport from Surgery
  • with a lid
  • easily cleaned
  • puncture and leak proof
  • kept in a clean, dry condition
  • not overloaded
  • carefully packed
    • sharps recognised
    • facing same direction
1 3 sorting prior to cleaning
1.3 Sorting Prior To Cleaning

Instruments and items sorted by;

  • Type
  • Method of cleaning e.g. Manual , ultrasonic,

Instruments and items are checked for;

  • Completeness
  • Defects
  • Sharps or blades that have not been removed
  • Heavily soiled items
  • Single use only items are not to be returned for reprocessing

Report concerns to supervisor

  • Cleaning removes organic and inorganic soil, blood, fats etc which contain pathogenic micro-organisms
  • Cleaning minimises contamination levels of bioburden (number of micro-organisms) prior to sterilisation
  • For sterilisation to occur the aim is to have a low number of micro-organisms present on instruments

Steam will not penetrate contamination left on instruments

If the item is not clean it won’t be sterilised

1 4 chemical detergent mixtures
1.4 Chemical & Detergent Mixtures
  • Breaking down and removal of
    • Blood, proteins and debris (organic soils)
    • Medicaments and chemicals (inorganic soils)
    • Breaks water tension – surfactant
    • Keeps the soils suspended in the water
  • Must be an “instrument” detergent. DO NOT use household type
  • Compatible with instruments and equipment
  • Material Safety Data Sheets (MSDS) – ChemAlert
  • Appropriate storage requirements
1 4 chemical detergent mixtures19
1.4 Chemical & Detergent Mixtures

Manual cleaning agents

  • Mild alkaline instrument detergent - optimal pH: 8.0 -10.8
  • Low foaming properties
  • Non-corrosive
  • Non-toxic
  • Non-abrasive
  • Free rinsing
  • Bio-degradable
  • Preferably liquid
  • Use and rate of concentration: as per manufactures instructions
1 4 chemical detergent mixtures20
1.4 Chemical & Detergent Mixtures

Mechanical cleaning agents

  • Mechanical washer manufacturer’s requirements

e.g ultrasonic or washer/disinfector

  • May be stronger alkaline pH range: 8.0-11.5
  • Biodegradable
  • Nonabrasive
  • Low foaming
  • Free rinsing
  • Preferably liquid
  • Use and rate of concentration: as per manufactures instructions
1 4 chemical detergent mixtures21
1.4 Chemical & Detergent Mixtures
  • Enzymatic Cleaners
  • Includes enzyme pre cleaners and enzymatic detergents
1 4 chemical detergent mixtures22
1.4 Chemical & Detergent Mixtures

Drying Agents/Rinse Aids – Washer disinfectors

  • Surfactants that “wet” the final rinse water
  • Automatically dosed into the final rinse water
  • Spreads evenly over a surface instead of beading
  • Beaded water leaves mineral salts
  • Not as effective on plastics
  • Load instruments and metals on the top racks with plastics on the bottom
  • Plastics on edge to allow drainage
1 4 chemical detergent mixtures23
1.4 Chemical & Detergent Mixtures

Acid Base Agents

  • Only on stainless steel surfaces
  • Only intermittently descaling or destaining
  • Dissimilar instruments should not processed at the same time
  • Mix the agent as per manufacturers instructions
  • Only mix when required and discard at end of the day
  • OHS -Chemical manufactures instructions , including safety precautions, dilution and instrument compatibility
  • OHS - Rubber or nitrile gloves
1 4 chemical detergent mixtures24
1.4 Chemical & Detergent Mixtures


  • Water miscible – able to mix with water
  • Compatible with the sterilizing agent
  • As per manufacturers instructions
  • Instrument stiffness needs to be investigated
  • Lubrication used intermittently
  • Routine use = heavy contamination
1 5 pre cleaning
1.5 Pre Cleaning
  • Pre cleaning (initial cleaning) allows for the removal of visible blood, body fluids and debris from items prior to cleaning (definitive cleaning). Pre cleaning shall be undertaken as soon as possible (e.g. during and post procedure chairside).
  • If blood, proteins and other debris are allowed to dry or remain in crevices and joints, the instruments become very difficult to clean and are prone to stiffness and accelerated corrosion.
1 5 pre cleaning26
1.5 Pre Cleaning
  • Pre cleaning can be performed by methods such as dry wiping, damp wiping or use of a commercially available single use only instrument sponge
  • Place the dry wipe, damp wipe or sponge on the bracket table and carefully wipe the instrument across the material
1 5 pre cleaning27
1.5 Pre Cleaning

Rinsing removes excess blood and debris

  • Prevents blood and debris drying on items
  • As soon as possible - post procedure
  • Reduces bioburden - micro-organisms will multiply rapidly
  • Use warm water
    • hot water coagulates protein
    • cold water - congeals fats
1 6 hand cleaning for immersible items
1.6 Hand Cleaning For Immersible Items
  • Automated cleaning of instruments is the preferred practice, but not always feasible
  • Identify instruments that cannot be immersed under water for manual cleaning
  • Two dedicated sinks large, deep enough for practical use
  • Separate hand washing facility
1 6 hand cleaning for immersible items29
1.6 Hand Cleaning For Immersible Items
  • Warm water – potable (drinkable)
  • Instrument brushes various sizes
  • Disposable low - lint cloth
  • Suitable instrument detergent Ph: 8
  • Pressure equipment
    • High pressure water
    • Air pressure
    • Disposable Syringe
  • Non abrasive pad
double sink operation
DoubleSink Operation
  • The first sink is to be always used for the initial rinse of instruments only and does not need to be cleaned between use.
  • The second sink is to be used for the cleaning and the final rinse of instruments and only needs to be cleaned between these two activities if the instrument cleaning water is discoloured or cloudy.
  • NB all sinks must be cleaned at the end of the day
single sink operation
Single Sink Operation
  • The sink is to be cleaned with a detergent impregnated wipe between the first rinse of the instruments and the filling of the sink for cleaning the instruments.
  • Following cleaning of the instruments and before the final rinse the sink only needs to be cleaned with a detergent impregnated wipe if the cleaning water is discoloured or cloudy.
  • NB all sinks must be cleaned at the end of the day,
1 6 hand cleaning for immersible items32
1.6 Hand Cleaning For Immersible Items

Standard Precautions

Heavy duty gloves & PPE

Initial Rinse - rinse instruments under warm running water

Fill sink correct ratio of warm water and suitable detergent

Identify instruments that require manual cleaning

Disassemble and open items

Inspect for damage or parts missing

Immediately notify the supervisor and contact user area

1 6 hand cleaning for immersible items33
1.6 Hand Cleaning For Immersible Items

Limit the generation of aerosols

Holding item low in the sink under the water line

Apply adequate friction

Visualise item under the water line

Prevent against sharps injury and damage to the instrument

Final rinse – Rinse thoroughly under hot running water

Check that the item is clean LOOK and CHECK

Use a magnifying glass if necessary

1 6 hand cleaning final rinsing
1.6 Hand Cleaning - Final Rinsing

Final rinsing facilitates the drying of item

  • Use warm water
  • Mechanical washer disinfectors use hot water
  • Removes chemical residues
    • Tissue irritation
    • Instrument damage
  • If a demineralised/reverse osmosis water system is installed, rinse with demineralised/ reverse osmosis filtered water.
1 6 hand cleaning for immersible items35
1.6 Hand Cleaning For Immersible Items

Cleaning brushes

Check no broken bristles or requires replacing

Kept free of visible debris during, after use and before reuse

Single or limited use cleaning materials

Single use, non-abrasive cleaning brushes are disposed of at the end of the day.

Reusable cleaning brushes are to be thermally disinfected at the end of the day and stored dry.

unsuitable cleaning agents or equipment
Unsuitable Cleaning Agents or Equipment
  • steel wool or other harsh abrasives
  • cleaning powders
  • excessive temperatures
  • dangerous chemicals
  • corrosive chemicals
1 6 hand cleaning for immersible items37
1.6 Hand Cleaning For Immersible Items

Flush, Brush and Flush all lumen items

Flush lumen with water

Wet bristles of correct size instrument brush

Pass instrument brush through the lumen and rinse debris off brush tip in an appropriate cleaning solution

Withdraw brush

Flush through with running hot water 

Repeat until clean

1 6 hand cleaning for immersible items38
1.6 Hand Cleaning For Immersible Items

Drying – As per manufacturer’s instructions

Drying cabinet

Disposable low-lint cloth for hose, battery and external parts

Air pressure gun (for removal of excess moisture)

Disposable syringe

1 6 hand cleaning for immersible items39
1.6 Hand Cleaning For Immersible Items

Problems associated with incorrect drying

  • Items should NOT be air dried/ dripped dry

Good conditions micro-organisms multiply in 20-30 minutes

  • Wet packaging result in unsterile item
  • Can cause rusting, corrosion, pitting to the item
1 7 hand cleaning for non immersible items
1.7 Hand Cleaning For Non-immersible Items

For those items that are unable to be submerged under water

  • Some items e.g surgical handpieces and attachments, may need hoses or caps attached to prevent water entering delicate parts
1 7 hand cleaning for non immersible items41
1.7 Hand Cleaning For Non-immersible Items
  • Initial rinse - Some items may be gently rinsed with warm water to remove gross soil as per manufacturer’s instructions.
  • Initial rinse - Some items may be rinsed using a low lint cloth immersed in water if the item cannot be placed under gently running water
  • Fill sink correct ratio of warm water and suitable detergent
  • Items are wiped using a clean cloth immersed in the clean, warm water with detergent added
  • The cloth is squeezed (wrung out) to prevent water entering the instrument, it is damp only, and not dripping wet
1 7 hand cleaning for non immersible items42
1.7 Hand Cleaning For Non-immersible Items

The impregnated damp cloth is rubbed over the item

May need to be repeated depending extent of soiling

Handpieces that cannot be immersed in water follow the manufacturer’s instructions

Non-immersible cannulated items - the manufacturer’s instructions must be adhered to in relation to flushing and brushing

1 7 hand cleaning for non immersible items43
1.7 Hand Cleaning For Non-immersible Items

Following washing the detergent must be removed

FINAL RINSE - Using a damp clean low lint cloth (that has not been in contact with detergent), wipe over the item to remove the detergent. Note if a demineralised/reverse osmosis water system is installed, rinse with demineralised/ reverse osmosis filtered water

These steps may need to be repeated to remove all traces of detergent (Dry as per instructions in SOP 1.6 immersible item)



outside surfaces cleaned using detergent wipe,

rinsed by wiping


slow speed motors

outside surfaces cleaned using detergent wipe,

rinsed by wiping,


lubricated (manually or automatic) may need special adaptors

Dried, wrapped & processed in a wrapped cycle

special adaptors may be needed46
Special adaptors may be needed
  • Ideally, handpieces and slow speed motors are cleaned and lubricated using mechanised cleaning equipment
1 8 ultrasonic cleaner
1.8 Ultrasonic Cleaner


Ultrasonic cleaning is a form of mechanical cleaning that uses high frequency ultrasonic waves (cavitation) that dislodges fine particles from the surfaces of instruments.


Ultrasonic cleaning is an effective cleaning method for instruments prior to the reprocessing

1 8 ultrasonic cleaner50
1.8 Ultrasonic Cleaner
  • Minimises manual cleaning
  • Does not disinfect instruments
  • Remove debris using cavitation (sound waves)
  • Detergent as per manufacturer’s instructions
  • Requires degassing before use
  • Rinsing after use (if no further washer/disinfector processing)
  • OHS – do not immerse hands when operating
  • OHS – aerosols – use lid when operating
  • OHS – noise – use lid & hearing protection
  • OHS – dry hands – when handling electrical leads and turning on or off at power point.
1 8 ultrasonic cleaner51
1.8 Ultrasonic Cleaner

Follow manufacturer’s instructions

Newer models may have different requirements

Fill the tank with water

(may be cold or warm follow manufacturer’s instructions)

Then add the specified amount of detergent

Degas the water – close the lid for recommended time

Lumen instruments undergo manual cleaning first (FBF)

Initial Rinse – Rinse all items with warm water to remove gross soil before placing into designated baskets

Disassemble and open items

1 8 ultrasonic cleaner52
1.8 Ultrasonic Cleaner

Place instruments in basket as per manufacturer’s instructions. Do not overload basket as ultrasonic waves will be unable to penetrate the soil on the instruments

Never place items on the floor as transducers will be damaged.

Place delicate or small pieces of items into lock down baskets

Fully submerge the items below the waterline.

Close lid and operate for recommended time

1 8 ultrasonic cleaner53
1.8 Ultrasonic Cleaner

For bench top ultrasonic cleaning, use clean gloved hands

Final Rinse - Thoroughly rinse instruments with warm running water

Lumened items to have excessive moisture removed by air pressure gun or disposable syringe

Dry using a drying cabinet or with a disposable low lint cloth

1 8 ultrasonic cleaner54
1.8 Ultrasonic Cleaner


Daily and if solution becomes murky or discoloured as cleaning cannot occur in dirty solution.

Routine cleaning of the ultrasonic machine is required see

(SOP 5.9 Routine Cleaning Reprocessing Equipment)

1 9 washer disinfector machines
1.9 Washer Disinfector Machines
  • Batch and continuous type washer disinfectors clean and remove bio burden/micro-organisms (blood and debris)
  • Thermal (high level) disinfection using time at temperature – final rinse
  • Means the cleaning process is verifiable
  • Lumened items still require Flush brush Flush
  • Unlock and open items
  • Use appropriate washer baskets/inserts
  • Keep sets together
1 9 washer disinfector machines56
1.9 Washer Disinfector Machines


Lumen instruments have been flushed, brushed and flushed

Use specific washer insert that is required e.g. dental handpieces

Disassembled, unlocked, opened (e.g. forceps, needle holders, scissors)

Ensure parts of disassembled instruments are together

Use disk or tags to identify instrument trays when using multiple baskets

Small/light items placed in lidded basket with hold down catch

1 9 washer disinfector machines57
1.9 Washer Disinfector Machines


If using barcode baskets select correct basket

Load the baskets/racks ensuring they are not overcrowded or over opened

Use a hold down screen

Hollowware is loaded in a draining position

Minimise lifting of racks

Make sure equipment stays in the parameter of the rack.

Select the appropriate cycle for the load

1 9 washer disinfector machines58
1.9 Washer Disinfector Machines


Cycle parameters not meeting set requirements or variations to cycle parameters – failed cycles

Items that appear dirty or stained are returned to the cleaning area for recleaning/destaining

Excess water – check the following: the machine temperature, amount of rinse aid going into the machine or the way in which the machine was loaded

Damaged instruments

1 10 washer disinfector machines
1.10 Washer Disinfector Machines

Releasing the load and unloading the washer disinfector

Authorising release of the load occurs on completion of washer disinfector cycle and prior to opening the door.

Check cycle parameters have been met and print out/log (or equivalent) is signed

Care opening the doors due to heat and moisture

Inspect load not become dislodged or displaced

Avoid injury and damaging the equipment/instruments

1 9 washer disinfector machines61
1.9 Washer Disinfector Machines

UNLOADING continued

Check for cleanliness

If machine does not dry - place into drying cabinet

Industrial dry and oil free compressed air used to remove excess moisture from lumen instruments.

Only when dry, place instruments onto designated work benches to await packing/wrapping

1 10 de staining
1.10 De-staining

Stains = corrosion, pitting or other damage

Staining can occur

  • Chemical incompatibility
  • Water quality
  • Interaction of alloys in instruments

Investigate cause

1 10 de staining63
1.10 De-staining

Occupational Health & Safety


Acid based de-staining chemicals are a strong acid and can cause burns to hands, eyes etc.

Read and follow the manufacturer’s instructions and precautions.

Refer to MSDS for first aid instructions

1 10 de staining64
1.10 De-staining

Only use intermittently NOT ROUTINELY

Check de-staining solution is compatible

Usually only stainless steel instruments.

Standard precautions

Wear protective clothing + heavy duty gloves

Use a container with a good fitting lid

Strictly follow manufacturer’s instructions on water temperature, chemical ratio and exposure time

Dissimilar instruments not processed at the same time

1 10 de staining65
1.10 De-staining

Remove item using gloved hands

After exposure item re-washed to remove chemical residue

Only mix de-staining solution when required

Change chemical daily or more often if solution discoloured.

Remove gloves and wash hands.

Identify and report any patterns of staining

1 11 drying cabinet
1.11 Drying Cabinet


To dry the cleaned item prior to wrapping and packaging and prevent damage that occurs to the item if it is left wet.



OH & S considerations